how to use cardiac spect & pet

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nuclear cardiology has high potential role in planning of treatment of Coronary artery disease. recent advances in SPECT and PET have evolved and found highly informative in both early diagnosis , taking of proper decision of mode of treartment and followup of CAD cases.

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SPECT PET:

SPECT PET DR . K.M.LAKSHMIPATHY HEAD DEPT.OF.NUCLEAR MEDICINE & PET-CT CENTRE Dr.Kamakshi M emorial H ospital chennai India. How to use ? cardiac

CARDIAC DISEASE DIAGNOSTIC MODALITIES:

CARDIAC DISEASE DIAGNOSTIC MODALITIES ECG , ECHO CT MRI ANGIO SPECT PET PET-CT

What u r looking for?:

What u r looking for? Anatomy ? Function ? 1.Perfusion 2.metabolism Despite an excellent negative predictive value, CTA is a poor discriminator of patients with myocardial ischemia. Conversely, a normal stress SPECT / PET study is a poor discriminator of patients without evidence of non—flow-limiting (subclinical) coronary atherosclerosis. These results suggest potentially complementary roles of CT and perfusion imaging in the evaluation of patients with suspected CAD.

SPECT:

SPECT SHORT AXIS ,VERTICAL & HORIZONTAL LONG AXIS ORIENTATION

Spect radiotracers:

Spect radiotracers tracer half life injections dose Tc99m sestamibi / tetrofosmin 6 hrs two 8 to 10 mci at first study 20 to 30 mci at second study Tl 201 73 hrs single 4 to 6 mci Protocols Stress & rest study done in the same day or separately two days Only rest study

TMT/Adenosine/Dobutamine stress:

TMT /Adenosine/ Dobutamine stress

20 SEGMENTS OF LV SCORING:

20 SEGMENTS OF LV SCORING

Myocardial ischemia :

Myocardial ischemia

Myocardial infarct:

Myocardial infarct

SPECT-CT:

SPECT -CT

CLINICAL INDICATIONS:

CLINICAL INDICATIONS

PET AND CYCLOTRON:

PET AND CYCLOTRON

CARDIAC PET TRACER:

CARDIAC PET TRACER

Cardiac PET indications:

Cardiac PET indications Coronary vascular reserve ( CVR )

PET-CT:

PET-CT

SEPCT/PET Perfusion & PET metabolism:

SEPCT /PET Perfusion & PET metabolism STRESS : AMMONIA 18 ( N13) RUBIDUM 82 ( Rb 82) or Tc99m sestamibi or Tetrofosmin rest and Rest F18 FDG Hibernating Stunning Infarct/scar

PET and CT hybrid images obtained from a 60-year-old man with diabetes and hypertension undergoing investigation for chest pain:

PET and CT hybrid images obtained from a 60-year-old man with diabetes and hypertension undergoing investigation for chest pain PET-CT

PET CORONARY FLOW RESERVE (cfr):

PET CORONARY FLOW RESERVE ( cfr ) absolute myocardial flow in milliliters per minute per gram, and coronary flow reserve open profound new windows into the heart with awaiting discoveries and clinical applications. Quantitative PET perfusion images show the entire range of absolute flows and coronary flow reserves of each artery down to small branches with single or multiple stenosis, diffuse disease, and/or myocardial steal indicating collateralization,

SUMMARY : importance of functional imaging for the detection of coronary artery disease :

SUMMARY : importance of functional imaging for the detection of coronary artery disease The ischaemic cascade reflecting the order in which pathophysiological changes during ischaemia will occur.

Thank you:

Thank you SPECT stress & rest or rest only 1.Normals & risk group Stress induced ischemia 2.CAD pre & post intervention and follow up 3.Presurgical base line & followup PET stress & rest Or rest only 1.CORONARY FLOW RESERVE ( CFR ) 2.hibernating/stunning myocardium 3.scar/infarction viability